Hospitalization Form - Craig Road Animal Hospital

Please only use this form if directed to by a member of Craig Road Animal Hospital’s staff as this form is used to authorize us to hospitalize your pet.

I hereby authorize Craig Road Animal Hospital to perform such diagnostic, therapeutic and surgical procedures as described in my signed estimate/treatment plan. The nature of such services has been described to me to my satisfaction and I realize that no guarantee or warranty can ethically or professionally be made regarding outcomes of treatment of medical illnesses.

I am the owner or the authorized agent for the owner of the animal described above, and I have the authority to execute this consent. My signature below certifies that I am over eighteen years of age.

The nature of these operations or procedures has been explained to me and I understand what will be done. I am aware there are no guarantees for successful treatment. I have been encouraged and given the opportunity to discuss any questions I may have regarding my pet’s medical care and my questions have been answered to my satisfaction. I accept that my financial obligations remain regardless of the outcome.

I have read and understand this authorization and hereby accept and agree to the terms of the consent for treatment. By writing your name, you are agreeing to the terms and conditions as stated above.

Pet Owner's Name (required)

Pet's Name (required)

Today's Date (required)

It is extremely important that you are reachable by phone while your pet in the hospital. In the case of medical emergencies and treatment decision making, the veterinarian will need your permission and often times it is critical to the outcome. If you cannot be reached by phone, do we have permission to treat and perform diagnostics if the doctor is unable to contact you and feels that these tests and treatments are necessary?

Please select one. (required)
YES - Please perform testing and/or treatment without my consent if I cannot be reached.NO - I do not want anything additional performed other than what is outlined in my signed estimate if I cannot be reached.

Best Contact Phone Number

Email Address

CPR / Life-Threatening Events

By consenting to this service, you are acknowledging that certain fees will apply. If you are not able to be contacted immediately, resuscitation efforts will be continued to be performed at the veterinarian's discretion. If I cannot be reached by phone within 30 minutes of CPR being initiated and my pet is unable to support cardiac or respiratory function on their own, I authorize the doctor on duty to make the decision to discontinue CPR which may result in my pet's death.

Please select one. (required)
I agree to heroic measures, including CPR, in case of a life-threatening emergency.I elect a Do Not Resuscitate status in case of a life-threatening emergency.